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1. Were you a member of the Jehovah's Witness organization? (Required.)

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2. What is your current status in regards to the Jehovah's Witnesses

  Still attend meetings No long attend meetings
Baptized Active
Baptized Inactive
Dissfellowshiped
Disassociation

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3. When you left did you experience any of the following: (Required.)

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4. Length of the above symptoms

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5. Did you self medicate with drugs and/or alcohol

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6. Were your sleeping patterns altered after leaving the Jehovah's Witnesses?

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7. Did you begin using tobacco after leaving the Jehovah's Witnesses?

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8. Do you missed people in the Jehovah's Witnesses organization?

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9. Frequency of your urges to return to the Jehovah's Witnesses. (Please be completely honest, please count even slight desires)

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10. If you could return to the Jehovah's Witnesses without any questions from anyone would you reinsert yourself into your old Jehovah's Witness self?

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